Campbell, B. C.V. et al. (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data.ABSTRACT Background: CT-perfusion (CTP) and MRI may assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of ischaemic core and penumbra volumes were associated with functional outcomes and treatment effect.
Naming is typically assessed with visual naming tasks, yet, some patients with genuine word-finding difficulty (evident in auditorily based discourse) show minimal difficulty on such measures. Evidence from cortical mapping, brain imaging and neuropsychological studies suggests that auditory naming measures might provide more relevant or at least, complementary information. We developed comparable auditory and visual naming tests and present normative data for accuracy, response time, and tip-of-the-tongue responses based on 100 controls. Test validity was supported by findings that left temporal lobe epilepsy (TLE) patients (i.e., a population with expected naming difficulty) performed more poorly on auditory but not visual naming compared to right TLE patients (i.e., a population without expected naming difficulty). Internal and test-retest reliability coefficients were reasonable. Finally, test utility was assessed on an individual basis, and auditory but not visual naming performance predicted impairment. (JINS, 2003, 9, 479-489.)
Campbell, B. C. V. et al. (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurology, 17(1), pp. 47-53. (doi:10.1016/S1474-4422(17)30407-6) This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/149670/ variables. An alternative approach using propensity-score stratification was also used. To account for between-trial variance we used mixed-effects modeling with a random effect for trial incorporated in all models. Bias was assessed using the Cochrane tool.Findings: Of 1764 patients in 7 trials, 871 were allocated to endovascular thrombectomy. After exclusion of 74 patients (72 who did not undergo the procedure and 2 with missing data on anaesthetic strategy), 236/797 (30%) of endovascular patients were treated under GA. At baseline, GA patients were younger and had shorter time to randomisation but similar pre-treatment clinical severity compared to non-GA. Endovascular thrombectomy improved functional outcome at 3 months versus standard care in both GA (adjusted common odds ratio (cOR) 1·52, 95%CI 1·09-2·11, p=0·014) and non-GA (adjusted cOR 2·33, 95%CI 1·75-3·10, p<0·001) patients. However, outcomes were significantly better for those treated under non-GA versus GA (covariate-adjusted cOR 1·53, 95%CI 1·14-2·04, p=0·004; propensitystratified cOR 1·44 95%CI 1·08-1·92, p=0·012). The risk of bias and variability among studies was assessed to be low.Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons. Funding:The HERMES collaboration was funded by an unrestricted grant from Medtronic to the University of Calgary. Research in contextEvidence before this study between abolition of the thrombectomy treatment effect in MR CLEAN and no effect in THRACE. Three single-centre randomised trials of general anaesthesia versus conscious sedation found either no difference in functional outcome between groups or a slight benefit of general anaesthesia. Added value of this studyThese data from contemporary, high quality randomised trials form the largest study to date of the association between general anesthesia and the benefit of endovascular thrombectomy versus standard care. We used two different approaches to adjust for baseline imbalances (multivariable logistic regression and propensity-score stratification). We found that GA for endovascular thrombectomy, as practiced in contemporary clinical care across a wide range of expert centres during the rand...
Event-related brain potentials (ERPs) were recorded from young, middle-aged, and older adults to infrequent target and novel stimuli during a version of the oddball paradigm. Analyses of scalp distribution suggested that the shift to a more frontally oriented topography with increasing age was confined to the P3 component (as compared to N1 and P2) elicited by both target and novel stimuli. This first demonstration of an age-related shift in the scalp distribution of the novelty P3 elicited by auditory stimuli was associated with an age-related increase in the false-alarm rate to novel stimuli. These age-associated differences in scalp distribution and false-alarm rate are consistent with a change in frontal lobe activity with increasing age.
Developmental differences in name agreement, familiarity, and visual complexity in response to line drawings of common objects were obtained from children and adults. Sixty-one pictures were taken from the Peabody Picture Vocabulary Test-Revised and 259 pictures were taken from the set normed for adults by Snodgrass and Vanderwart (1980). Although there were some differences between the two sets of pictures, the present results replicated the relative independence of these three measures, which was reported by Snodgrass and Vanderwart for adults. Children and adults showed substantial agreement on the names of the pictures. Although the children's ratings were lower on all measures, the differences were trivial for most pictures. We concluded that judgments offamiliarity, complexity, and the names ofline drawings of common objects are based primarily on information processing accomplished prior to age 7. 371Cognitive psychologists have shown an increasing interest in the operations involved in the encoding, storage, and retrieval of pictorial stimuli. Snodgrass and Vanderwart (1980) addressed the paucity ofwell-eharacterized experimental picture sets by developing and norming a set of 260 line drawings of familiar concepts.Developmental investigations would also benefit from the use of standardized picture stimuli. For instance, Hitch and Halliday (1983) and Hulme, Silvester, Smith, and Muir (1986) studied the word-length effect, whereby longer words and their pictured symbols are recalled less often than their shorter counterparts (Schiano & Watkins, 1981). Hitch and Halliday found that 6-year-01ds did not exhibit this effect for pictures, whereas Hulme et al. reported the effect in children as young as 4 years old. However, Hitch and Halliday used a set of line drawings as their stimuli, whereas Hulme et al. chose color pictures taken from prereading books commonly used by young children. Clearly, it would help in interpreting studies like these if the same set of pictorial stimuli were employed, and if the attributes of those stimuli that might be rele-The authors wishto thank Charles L. Brown for computer programming, and Barry Dunayerand Margaret Cramer for data collating.
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